Bld 63, Level 4
Missenden Road, Camperdown
FRACP
EXAMINATION REVISION
Paper A
9th February 2002
MOCK EXAMINATION
Held in the Library
Q1. Which
of the following is TRUE regarding Gout :
b) Acute Gout results from the interaction of urate crystals
and lymphocytes
c) Allopurinol is useful for initial treatment of acute gout
d) Gout attacks are usually polyarticular
e) Urate crystals activate both classic and alternate
pathways
Q2. In
regards to venous thrombosis during pregnancy, which of the following is false
:
a)
Women
who experience a DVT during pregnancy are an increased risk of future
thromboembolism
b)
Pregnancy
is associated with increase in von Willebrand factor, factor VIII, fact V and
fibrinogen together with an acquired resistance to protein C and reduced
concentration of protein S.
c)
Most
cases of venous thrombosis in pregnancy are calf vein thromboses
d)
Pregnancy
is associated with a decreased level of homocysteine
e)
Warfarin
is safe to use during lactation
Q3. Regarding
the antiphospholipid syndrome, which of
the following is false:
a)
Thrombocytopenia
is an occasional feature of the antiphospholipid antibody syndrome
b)
Antiphospholipid
antibodies can occur in a variety of infections including HIV, CMV and
hepatitis C
c)
Both
lupus anticoagulant and anticardiolipin antibodies are positive in >80% of
patients with antiphospholipid syndrome
d)
The
titire of IgG anti-cardiolipin is a prognostic marker
Q4. Which one of the following is false;
It is true of
Creutzfeldt-Jakob prion disease that;
a)
The
pathological change involves the prion protein switching from an beta-pleated
sheet to an alpha-helical
structure
b)
Diagnosis
is suggested by the typical clinical course of
inexorable progression, with the dissolution of cognitive abilities and
the development of myoclonic jerking, particularly startle myoclonus and
eventually the subsiding of the jerks
c)
Magnetic
resonance imaging may show hyperintense signals in the basal ganglion on T(2)
weighted images
d)
Amyloid
plaques are common in kuru and new-variant Creutzfeldt-Jakob disease but not in
classical Creutzfeldt-Jakob disease
e)
The
familial variant is autosomal dominant, associated with coding abnormalities on
the PrP gene, has an earlier age of onset, longer time till death than the
sporadic disease and has distinct diagnostic findings
Q5. Which one of the following is false;
It is true of melantonin that,
a)
The
daily rhythm of melatonin secretion is controlled by an endogenous,
free-running pacemaker in the suprachiasmatic nucleus
b)
The
activation of (alpha)(1) and (beta)(1)-adrenergic
receptors in the pineal gland raises cyclic AMP and calcium concentrations and
activates arylalkylamin N-acetyltransferase, initiating the synthesis and
release of melatonin
c)
In
humans, melatonin secretion increases soon after the onset of darkness, peaks
in the middle of the night (between 2 and 4 am) and gradually falls during the
second half of the night
d)
Increasing
serum melatonin concentrations (to normal night time values or pharmacologic
values) can trigger the onset of sleep, regardless of the prevailing endogenous
circadian rhythm
e)
Men
with hypogonadotropic hypogonadism have decreased serum melatonin
concentrations, which increase in response to treatment with testosterone
Q6. With regard to Charcot-marie-tooth
disease, which one of the following is false;
a)
Cramps
are a frequent complaint and are worse after long walks
b)
The
plantar reflex is frequently flexor or absent
c)
Vibratory
sense is the most frequently affected modality
d)
Phenotype
is closely related to genotype
e)
CMT
type 1 (CMT1) is a demyelinating neuropathy with moderate to severely decreased
motor nerve conduction velocity (where the clinical features appear to be due
to fiber loss and denervation), while type 2 (CMT2), the neuronal form, shows
normal or only mildly reduced nerve conduction velocity
Q7. With
regard to lobar intracerebral hemmorhage, which one is false:
a)
it
is associated with hypertension
b)
the
main pathological feature is infiltration of the cortical vessels by amyloid
beta-protein
c)
Often
associated with andecedant memory loss
d)
Apo
E4 and E2 are predictors of recurrent hemmorhage
e)
Familial
syndromes are associated with mutations in the gene for amyloid precursor
protein and cystatin C
Q8. With regard to acute normovolaemic haemodilution (where whole
blood is removed from the patient immediately before surgery and simultaneously
replaced by crystalloid or colloid and then intra or immediately
post-operatively infused back into the patient) which of the following are
false:
a)
It
should be considered when the potential surgical blood loss is likely to exceed
20% of the blood volume.
b)
It
is contra-indicated in patients with an Hb below 100 preoperatively and those
who have severe myocardial disease
c)
Because
the units never leave the room they do not require testing and are thus
considerably cheaper than autologous blood transfusion
d)
Because
they are not refrigerated there is a higher risk of bacterial contamination
than in autologous or allogeneic blood transfusion
e)
The
process decreases the need for post-operative allogeneic blood transfusion when
compared with usual practice.
Q9. A 50 yr old man presents with fatigue, weight loss and left
lower flank pain of several month’s duration.
On examination the only abnormality is an enlarged spleen abutting his
left iliac crest. After further investigation
he is found to have CML with <10% blast cells in the bone marrow and the
philadelphia chromosome. Unfortunately
he does not have any siblings.
The best treatment for him is:
a)
Long
term interferon alpha
b)
Hydroxyurea
c)
Matched
unrelated bone marrow transplantation within a year of diagnosis
d)
MUD
transplantation once he enters the accelerated phase of the disease
e)
Infusion
of donor lymphocytes
Q10. With
regard to the philadelphia chromosome, which of the following is incorrect?
a)
In
the majority of patients it is a translocation involving chromosomes 9 and 22
b)
It
produces a fusion protein BCR/ABL which is an intracellularly active tyrosine
kinase
c)
It
is found in approximately 25% of adult acute B cell lymphoblastic leukaemias
d)
Fusion
proteins of different sizes correlate with different clinical outcomes
e)
It
is only found in cells from the myeloid lineage
Q11. Regarding
spherocytosis all except one is true:
a)
In
50%, the defect is in ankyrin
b)
In
25%, the defect is a Protein 3 mutation
c)
In
25% spectein deficiency is associated with a mild dominate form of
spherocytosis
Q12. Regarding PNH which one is false:
a) DAF (decay-accelerating factor) normally disrupts the enzyme
complexes from either the classical/alternative pathway that activate C3 and
C5
b)
CD59
inhibits the conversion of C9 by the MAC to a polynesic
complex capable of penetrating the membrane
c)
The
lack of DAF & CD59 make the cells more sensitive to the lytic
effect of complement
d)
The
platelets lack the above proteins and hence their life span is shortened
e)
The
activation of complement indirectly stimulates platelet aggregation and
hypercoagulability
Q13. The
most sensitive and specific test for the diagnosis of PHN:
a)
Hams’s
test
b)
Sucrose
lysis test
c)
Flow
cytometry
d)
Direct
Coomb’s test
e)
Hemoglobinuria
Q14. Regarding
TTP, which one of the following is false:
a)
The
thrombocytopenia generally parallels
the anemia
b)
A
positive ANA can be obtained in 20% patients
c)
Neurologic
symptoms develop in more than 90% of patients whose disease terminates in
death.
d)
Positive
direct Coomb’s test
e)
Renal
manifestations are usually seen when the platelet count is very significantly
reduced
Q15. Warm –
antibody immune hemolytic anemia can be seen in the following except:
a)
CLL
b)
SLE
c)
a - methyldopa
d)
Penicillin,
Quindine
e)
Infectious
mononucleosis
Q16. All of the following complement components are required in the
alternative pathway EXCEPT:
a)
C1,
C2, C4
b)
C5,
C6, C7
c)
C3
d)
C8,
C9
e)
Properdin
Q17. In
Alzheimers disease, which of the following is false:
a)
Neurofibrillary
tangles represent abnormal phosphorylated tau protein
b)
Mutations
in PS-1 tend to produce AD with an earlier age of onset
c)
Mutations
in PS-2 tend to produce a shorter, more rapidly progressive course than
mutations in PS-1
d)
PET
studies indicate the earliest metabolic changes occur in parietal cortex
e)
Mutations
in chromosome –1 4 gene are the most common cause of early onset familial AD.
Q18. Which neurological disease is not associated with an increased
number of unstable CAG repeats:
a)
Huntingtons
disease
b)
Friedreich’s
ataxia
c)
spinocorebellar
ataxia
d)
dentatorubropallidoluysian
atrophy
e)
spinal
and bulbar muscular atrophy
Q19. The
pathological hallmark of Parkinsons disease :
a) Lewy bodies in substantia nigra
b)
neurofibrillary
tangles
c)
silver
staining cytoplasmic inclusions
d)
loss
of cells in substantia nigra
e)
Decrease
GABA in basal ganglion
Q20. Regarding
the elderly and depression which one of the following is false:
a)
Pts
receiving antidepressants to contol behavioural symptoms of dementia had more
falls than those receiving the drug for drepression
b) need to continue antidepressant Rx for at least 26 weeks after remission of symptoms or the risk of relapse is high
c) Pts receiving TCA have a higher rate of falling compared with those not using antidepressants.
d) SSRIs generally do not cause postural hypotension
e) SSRIs are not associated with a higher rate of falls
Q21. With
regard to haemochromatosis, which of the following statements is incorrect?
a)
The
frequency to haemochromatosis gene in Caucasian populations is 5-15%
b)
The
arthropathy of haemochromatosis usually improves with venesection
c)
The
risk of hepatoma in patients with established cirrhosis secondary to
haemochromatosis is not altered by venesection
d)
The
screening test family members is serum transferrin saturation
Q22. Regarding
patients with Gilbert’s syndrome, which of the following statements is/are correct?
a)
They
have a benign conjugated hyperbilirubinaemia
b)
Patients
may have pruritus during episodes of jaundice
c)
They
may have an enlarged spleen
d)
The
prothrombin time may be prolonged
e)
Patients
show increasing hyperbilirubinaemia during a prolonged fast
Q23. With
respect to myeloma, which of the following statements is correct?
a)
The
paraprotein is IgG in about 50% patients
b)
A
monoclonal peak is detected on serum protein electrophoresis in all patients
c)
Monoclonal
gammopathy of unknown significance evolves into myeloma in the majority of
cases within 5 year
d)
An
IgM paraprotein is rare
e)
At
presentation, 25% of patients have symptoms of hyperviscosity
Q24. The “exo-erythrocityc” or hypnozoite phase of Plasmodium vivax
infection in the liver, which is responsible for relapse, is affected by which
of the following?
a)
Chloroquine
b)
Quinine
c)
Proguanil
d)
Primaquine
e)
Fansidar (pyrimethamine plus sulfadoxine)
Q25. A patient has been diagnosed as having Parkinson’s desease. Which of his following complaints is/are unlikely to be explained by this disease?
a)
Constipation
b)
Neurogenic
bladder
c)
Loss
of convergence of the ocular muscles
d)
Impairment
of vertical gaze
e)
Profuse
sweating
Q26. Which of the following statements about acute inflammatory
demyelinating polyradiculoneurpathy (Guillain-Barre syndrome, GBS) is
incorrect?
a) Back and leg pain is a common early symptom
b) It may be the first manifestation of infection with the human immuno-deficiency virus (HIV).
c) Nerve conduction studies provide useful prognostic information
d) Steriods are beneficial in severe acute disease
e) Plasmapheresis is beneficial in severe acute disease
Q27. Which of the following drugs, if taken by a nursing mother, would be a contra-indication to breast feeding?
a) Digoxin
b) Warfarin
c) Prednisolone
d) Lithium
Q28. With regard to osteoporosis which of the following are correct?
a) The risk of a 50 yr old woman sustaining a hip fracture during the remainder of her life is approximately 40%
b) The reduction in BMD of 1 SD is associated with a 1.5-3x increased risk of fragility fracture
c) Osteopenia is defined as a BMD between 1-25 SD below young adult mean
d) Increasing femoral length is directly associated with risk of hip fracture independent of bone mass in the hip
e) Alcohol and smoking are risk factors for low bone mass and fracture in both men and women
Q29. With regard to HRT which are correct ?
a) RCT show ~50% reduction in CVS mortality in women who are current users of HRT
b) Combined continuous HRT induces a more favourable effect on lipid status of postmenopausal women than sequential HRT regimens
c) Approx 50% of the beneficial effect of HRT on CVS system is mediated via non-lipid effects
d) RCT indicate a 30% increase in risk of breast cancer among women using HRT for more than 5 yrs after menopause
e) Estrogen only HRT is favoured for women who have not undergone endometrial resection
Q30. Following are Physiological changes during pregnancy except:
a) Increase in cardiac output by 30%
b) Retention of potassium
c) Increase in urinary calcium
d) Decrease in urinary albumin excretory rate
e) Filtration faction falls, then rises to normal in late pregnancy
Q31. All of the following are true except;
ARTHRITIS X-RAY APPEARANCE
a) Psoriatic arthritis- pencil in cup
b) Gout - Erosions with overhanging margins
c) CPPD - Chondrocalcinosis
d) Reactive arthritis - axial skeleton Ü symmetric sacroilitis
e) SLE - non erosive
Q32. Which of the following is associated with a decrease in ESR ;
a) Anemia
b) High cholesterol
c) Female
d) Age
e) C.C.F.
Q33. Which of the following gastric mucosal cells is best described by the following?
Stimulated by gastrin
Stimulates acid secretion
Contains histamine
Pancrine function
Stains with silver
a) Paneth cell
b) Enterchromaffin-like (ECL) cell
c) Somatostatin (D) cell
d) Gastin (G) cell
e) Mast cell
Q34. Which of the following gastric cell types is the predominant source of histamine in response to gastrin stimulation?
a) Paneth cells
b) Chief cells
c) Enterochromaffin-like (ECL) cells
d) Mast cells
e) Parietal cells
Q35. A man aged 58 years on digoxin 0.25 mg daily for many years had a
creatinine level of 0.08 nmol/l and a serum digoxin concentration of 2.0 nmol/l
. He developed a persistent
supraventricular arrhythmia and was put on an additional antiarrhythmic drug. Four days later he complained of vomiting
and diarrhoea. His serum digoxin
concentration was 4.3 mmol/l and his creatinine unchanged.
Which one of the following drugs could not have been
the antiarrhythmic?
a)
Quinidine
b)
Disopyramide
c)
Verapamil
d)
Amiodarone
e)
Flecainide
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